We fight to save lives. We fight systemic inequities, lack of resources, and ethical dilemmas.

But the fights I was not prepared for were fights between colleagues. The subtle, insidious kinds that wear away at morale, breed toxic workplace culture, and add fuel to the fire of the burnout crisis.

While charting on the day’s patients, I see a message from a trainee on another service. It starts out clinical, cordial even, but the rapid collapse in communication leaves me reeling.

“I’m not asking for your opinion. Just transfer them to your damn service!”

I take a deep breath, a knot of anger twisting in my chest. I steel myself against the impulse to engage.

“There’s no indication for psychiatric admission,” I state plainly as I fire off an email to the trainee’s program director. I select ‘Do Not Disturb,’ as though this will magically shield me from future aggression. And I can’t help but wonder if my assailant has, too, endured a barrage of verbal assaults by noon. Perhaps their attack on me is a final attempt at self-preservation.

Sadly, this encounter is far from rare.

When we talk about violence in healthcare, we typically refer to patient aggression, which deserves ample attention. But what about the violence we inflict on each other?

It is long past time we confront it.

Clinician-on-clinician violence is not only prevalent — it’s normalized. It is not isolated to one department or group; it is woven into the very fabric of healthcare culture.

As a consultation-liaison psychiatrist, I have a front-row seat to these unfortunate dynamics. As I step into an elevator, a nurse brushes away a runaway tear. As I stroll down the hall to my next patient, I hear an attending snapping at a trainee in rounds. At the nursing station, a social worker’s concerns are laughed off.

“It’s just work,” a colleague shrugs as I vent, defeated, in their office. “It’s like this everywhere. Pay it no mind.”

But I cannot afford to pay it no mind; none of us can anymore.

The wounds add up. Trust is eroded. Collaboration fails. Everyone suffers, including our patients, who did not consent to be cared for by someone in the midst of a flashback to their latest workplace argument.

Each one of us is aware of this pattern. I know this because we laugh at it every day: reels about feuds between the nephrologist and cardiologist, memes about a nurse’s disdain for a doctor’s orders, comedic tropes about the medical student trembling at the thought of calling a surgery consult…

These moments are not just social media satire — though perhaps humor is sometimes the only coping skill we can access — they are real, and they carry tangible consequences.

More than 50% of physicians in the U.S. have experienced burnout in the last decade, and workplace culture, lack of support, and authoritarian leadership are risk factors. Physical violence understandably increases risk for burnout and PTSD, but studies show that the most common forms of workplace violence are verbal and psychological; and these, too, have a significant negative effect.3,4

The most effective healthcare teams are built on trust, respect, and communication. When we normalize aggressive behavior, dismissive attitudes, and toxic atmospheres, we undermine those very foundations.

The healing begins with us. We can start by acknowledging the problem publicly. Accountability begins when we name behaviors for what they are and decline to tolerate them. Provider-on-provider violence is not a normal and unavoidable “part of the job”; it is a serious epidemic that affects provider well-being and patient care. As such, the responsibility to challenge it falls on everyone, including healthcare leadership, and includes:

• Openly recognizing the issue and actively challenging the narrative that provider-on-provider violence is a normal, unavoidable aspect of healthcare
• Destigmatizing reporting of any form of violence by providing clear and confidential channels and openly addressing fear of retaliation or judgment.
• Promoting open and honest communication between team members and encouraging feedback and respectful disagreement.
• Equipping healthcare providers with the tools, language, and support they need to assertively challenge toxic behavior and advocate for themselves and their colleagues.

We also need to establish a zero-tolerance policy. Clear expectations are set by accurately defining workplace violence to include verbal and psychological abuse and disseminating written policy including:

• Provisions for training and education in recognition of provider-on-provider violence, safe reporting channels, communication skills, conflict resolution and de-escalation techniques.
• The roles and responsibilities of all levels of staff, including administration, in maintaining accountability.
• A clear outline of the consequences for engaging in violent behavior and systems for ensuring that these are consistently applied.

We can improve the work environments by addressing risk factors. Unrealistic expectations, high-stress environments, under-resourced settings, excessive work hours, lack of clarity on goals and responsibilities, and lack of autonomy frequently contribute to tension in the workplace. The same risk factors that fuel burnout place us at risk for provider-on-provider violence, strengthening a vicious cycle that can only be interrupted by systemic change that prioritizes healthcare workers’ well-being, not just retention. This includes safe staffing ratios, clear roles and boundaries of scope.

We must consistently focus on rest and recovery, social connection and psychological safety, not just access to mental health resources for when symptoms are already present. As healthcare providers, we know prevention is key. A dysregulated and fatigued nervous system is primed for perception of threat and heightened tension.

Tackling provider-on-provider violence requires a multi-faceted approach that combines cultural shifts, organizational changes, and systemic support. By confronting the normalization of violence, providing resources for conflict resolution, and promoting a culture of respect and empathy, healthcare institutions can create safer environments for both providers and patients.

The next time a colleague snaps at you or you witness interpersonal aggression, don’t ignore it. Don’t shrug it off as “just part of the job.” Call it out. Address it.

We owe it to ourselves and to the patients we serve to create an environment where respect, kindness, and collaboration are the standards, not the exceptions.

How have you worked to improve tense communication between colleagues in healthcare? Share below.

Dr. Angelova is the Director of Consultation-Liaison Psychiatry in a community hospital in New York City with special interest in healthcare leadership and physician burnout. She is also a wellness coach and author of "NOMERGENCY: Reclaiming Focus and Calm From False Urgency Culture." IG @no_mergency

Image by rob dobi / Getty Images